Pain and depression have a significant impact on quality of life (QoL) and activities of daily living (ADL) in patients with Myelin oligodendrocyte glycoprotein-antibody (MOG-ab)-associated disease (MOGAD), but pain and depression remain insufficiently controlled in these patients, according to study findings published in the European Journal of Neurology.

This exploratory cross-sectional study included 43 patients with MOGAD from the Neuromyelitis Optica Study Group (NEMOS) registry. Study researchers collected clinical, demographic, pain, depression, and health-related QoL (HR-QoL) via questionnaires. They assessed patients’ pain using the PainDetect questionnaire, Brief Pain Inventory Short Form, and the McGill Pain Questionnaire Short Form, while they assessed depression using the Beck Depression Inventory-II. Study researchers evaluated HR-QoL using the Short Form-36 Health Survey.

The mean age of the patient population was 39.2 years, and a slight majority of patients were female (67.4%). A total of 22 patients reported MOGAD-related pain, including nociceptive (n=11), definite neuropathic (n=8), and possible neuropathic (n=3) pain. 18 patients reported depression.


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Neuropathic pain was associated with the highest pain intensity and most profound impairment of ADL compared with nociceptive pain. Neuropathic pain was more often described as shooting (P <.001), sharp (P =.014), hot-burning (P =.018), and fearful (P=.032). Definite neuropathic pain was also associated with significantly more severe gait restriction compared with nociceptive pain (P =.032).

A total of 15 patients reported spasticity-associated pain, which included 4 patients with short-lasting painful tonic spasms. Chronic pain was associated with later disease onset (mean, 37.6 vs 29.3years, respectively; P =.039), profound physical impairment (median self-reported gait function value, 1 vs 0, respectively; P =.005), and depression (59.1% vs 25.0%, respectively; P =.034) in patients with MOGAD-related pain compared with those without.

Additionally, there was a higher prevalence of clinically relevant depression in patients with pain compared with patients without disease-related pain (59.1% vs 25%, respectively; P =.034). The only significant predictor for low mental QoL was clinically relevant depression (P <.001). Predictors of physical QoL included pain severity (P <.001), visual function (P<.001), and gait function (P =.005).

12 (54.5%) of patients with MOGAD-related pain received pain medications, while 4 out of 15 patients with spasticity-associated pain received antispastic medications.

A limitation of this study was the reliance on data from a self-administered questionnaire, which led to a lack of definite diagnoses of specific pain syndromes.

The study researchers concluded that while “pain and depression strongly affect QoL and ADL in MOGAD” and are highly prevalent, additional “research is needed to investigate precise underlying mechanisms and elaborate specific pain treatment strategies.”

Reference

Asseyer S, Henke E, Trebst C, et al. Pain, depression and quality of life in adults with MOG-antibody associated disease. Published online January 10, 2021. Eur J Neurol. doi:10.1111/ene.14729